老年公民逝世后器官捐献肝移植的临床疗效  

Clinical efficacy of liver transplantation using aged liver grafts from donation after citizen＇s death

作　　者：陈栋[1] 魏来[1] 蒋继贫[1] 刘斌[1] 张波[1] 冯锦城 李军[1] 曾凡军[1] 陈知水[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所教育部/国家卫生和计划生育委员会器官移植重点实验室,武汉430030

出　　处：《中华消化外科杂志》2016年第5期466-470,共5页Chinese Journal of Digestive Surgery

摘　　要：目的探讨老年公民逝世后器官捐献肝移植临床疗效。方法采用回顾性病例对照研究方法。收集2011年1月至2015年12月华中科技大学同济医学院附属同济医院收治的146例行公民逝世后器官捐献肝移植患者的临床资料。根据供者年龄，将46例接受年龄≥60岁供者供肝的肝移植受者设为供者年龄≥60岁组，100例接受年龄〈60岁供者供肝的肝移植受者设为供者年龄〈60岁组。观察指标包括：（1）术后原发性移植肝无功能（PNF）和移植肝功能恢复不良（IPF）的发生情况。（2）术后1月内肝功能恢复情况。（3）术后并发症发生情况，包括术后出血再手术、急性排斥反应、肝动脉血栓形成、门静脉血栓形成、胆道并发症、神经系统并发症、细菌性感染、巨细胞病毒感染和钙调磷酸酶抑制剂类药物不良反应发生情况。（4）肝移植受者术后生存率。采用门诊定期复查随访，随访内容包括实验室检查指标、肝移植术后并发症发生情况和患者术后生存情况。随访时间截至2016年1月。正态分布的计量资料以x^-±s表示，两组间比较采用独立t检验。偏态分布的计量资料以M（Qn）表示，采用Mann-Whitney检验。计数资料比较采用，检验。结果（1）术后PNF和IPF的发生情况：供者年龄≥60岁组肝移植受者中2例发生PNF，供者年龄〈60岁组中1例发生PNF，两组比较，差异无统计学意义（χ^2=1．754，P〉0．05）；供者年龄≥60岁组肝移植受者中8例发生IPF，供者年龄〈60岁组6例发生IPF，两组比较，差异有统计学意义（χ^2=4．716，P〈0．05）。（2）术后1个月内肝功能恢复情况：术后1周内，供者年龄≥60岁组肝移植受者ALT水平为（251±45）U／L，供者年龄〈60岁组肝移植受者ALT水平为（56±38）U／L，两组比较，差异有统计学意义（t=26．980，P〈0．05）。术后14d内，供者年龄≥60岁组肝移植受�Objective： To explore the clinical efficacy of liver transplantation using aged liver grafts from donation after citizen＇s death （DCD）. Methods The retrospective case-control study was adopted. The clinicopathological data of 146 patients who underwent liver transplatation using liver grafts from DCD at the Tongji Hospital of Huazhong University of Science and Technology from January 2011 to December 2015 were collected. Of 146 patients, forty-six recipients who received liver grafts from donors ≥60 years were allocated into the donor age≥60 years group and 100 who received liver grafts from donor age 〈60 years were allocated into the donor age 〈 60 years group. Observed indicators included： （1） the incidence of primary liver graft nonfunction （PNF） and initial poor function （IPF） of transplanted liver, （2） liver function recovery in the first postoperative month, （3） the postoperative complications, including reoperation because of bleeding, acute rejection, thrombosis of hepatic artery, thrombosis of portal vein, biliary complications, neurological complications, bacterial infection, cytomegalovirus infection and adverse reaction of calcineurin inhibitors, （4） postoperative survival rate in liver transplant recipients. The regular follow-up using outpatient examination was performed to detect indexes of laboratory examination and postoperative complications and survival of patients till January 2016. Measurement data with normal distribution were represented as x^- ± s and comparison between groups was evaluated with the independent t test. Measurement data with skewed distribution were represented as M（Qn） and analyzed by Mann- Whitney test. Count data were analyzed using the chi-square test. Results （ 1 ） The incidences of PNF and IPF of transplanted liver： two patients in the donor age≥60 years group and 1 patient in the donor age 〈60 years group had PNF, with no significant difference between two groups （χ^2 = 1. 754, P 〉 0. 05）. Eight patient

关 键 词：肝脏疾病 老年供肝 公民逝世后器官捐献 肝移植 

分 类 号：R657.3[医药卫生—外科学]